Recent investigations have suggested that although therapeutic portacaval anastomosis increases longevity, it is often associated with progressive liver failure and portalsystemic encephalopathy caused by diversion of portal blood around the liver. Distal or central splenorenal shunts have been devised which selectively decompress esophageal varices without interrupting the portal blood flow to the liver. It has been suggested that the presence of hepatotrophic substances in the portal blood will prevent the hepatic failure-portalsystemic encephalopathy syndrome. This study is designed to compare the efficacy of distal splenorenal shunts (including coronary vein ligation) with conventional portalsystemic shunts in the management of bleeding esophagogastric varices. Cirrhotic patients hospitalized with major hemorrhage will be candidates for the study. The site of variceal hemorrhage will be based on the endoscopic visualization of bleeding varices or by the presence of varices and the endoscopic and radiologic absence of any other potential site of hemorrhage. Patients who meet these criteria will have angiography to establish vascular patency and surgical suitability of the splenic, portal, and renal veins and to demonstrate prograde flow. Patients with retrograde portal venous flow will not be included in the study. Only those patients whose hepatic pressure gradient is greater than 10 mmHg will be randomized. After informed consent patients will be selected by sealed envelope technique to have either distal splenorenal shunt or portalsystemic shunt. All patients will be evaluated at regular intervals postoperatively.